OK, something here that has been bugging me for a while (along with other, more recent events that rankle as well). I never noticed it as much as an RN, because I never worked at a clinic for any length of time, but I am beginning to be of the opinion that everyone that darkens our door in the healthcare setting is only out for what they can get, at no cost to them.
Back when I graduated NP school, I was working for a doc who had a sample closet the size of my laundry room. Not big enough to park a yacht in, mind you, but HUGE for what it was for. Floor-to-ceiling shelves just covered in sample meds. The drug reps came by frequently, brought lunch most days, and always tried to keep us stocked. It was unreal. This doc would bag up handfuls of meds for people, usually the entire stock of what had just been delivered, and hand it off. I was amazed at how nice this seemed, but whan I got into the workings of it, I was appalled.
I would say that roughly 90% of her patients would come in and ask for sample refills. AT LEAST that many, and probably more. People would come in for rechecks and ask for more samples. People would get fighting mad when we either did not have what they needed in samples or were out (I am so sorry that Septra is not in a sample, it's on the $4 list!). Add into that that we got into trouble for attempting to ration the samples, so that MORE patients could share the wealth. People would refuse to take anything unless they got samples, saying that they could not afford it, but yet would have an iPhone, iPod, ICarly, nails, hair done to a fare-thee-well, and all the other various accoutrements that you could buy a house with in possession.
Two cases stuck out in my mind:
* A man and his wife who were, shall we say, quite healthy, were frequent flyers here. They each had several major health concerns, mostly due to their respective weights. The male was taking a very new, very expensive medication that we were hard pressed to get samples of, and he knew that we would give him first dig. One day, doc handed me the 2 sample boxes to give to him, all we had, and when I walked in, I get a baleful look and "Just TWO boxes?" Now, what I SHOULD have done is snatch them right back and tell him that since he obviously does not appreciate it, then he does not get it, like you would a child. What I DID do was explain that that was all we had. Neither of these folks worked, they refused to take steps to better their health, and they expected everything to be handed to them.
*A very ill gentleman (and I use the term loosely) brought his mother in with him for his visit. He had an infection for which she prescribed Septra. The mother told me "Well, we'll need samples of that." I explained that it was a very old med, and that there were no samples available, and she replied that he would not be taking anything, then. I never heard how he did.
Again when I went to my family doc to precept, I was shocked. He actually had people call and complain because the samples were not BIG enough! I have seen the same man for 25 years, have never once asked for a sample, have been grateful for what I have been given, and went on my merry way. It never occurred to me to ask or complain. When I ran out of samples, if they worked, I asked for a script. I though that was how it went. Silly me.
This blows my mind. We go all out to prescribe whatever the cheapest, most effective med is for what ails them, and if it is not free, they don't want it.
I know it can't just be here. Is it this bad where everyone else works?
If patients want free/cheap meds, they can go to the free clinic with the homeless and uninsured (which is what I do when I get sick because I am broke and have no insurance- since I have been in school on and off to work on my prereqs, I haven't been employed full time anywhere for long enough in the past few years to qualify for my employers' health insurance plans).
Anyway, I was having weird pain in my side this past Summer and went to the non-profit clinic in Eugene, OR. It turns out it was the beginning of a shingles outbreak (which is weird because I'm only half way to 60), and they gave me a prescription of Valtrex for only $10. I paid $20 total for the meds and the visit to the clinic, and it stopped the shingles outbreak before it erupted (thank GOD!). I had to show up at the clinic at 6 am, and ran the risk of not being seen that day because they can only see a very limited number of patients. I also went there last winter when I had a bad throat infection. It was kind of ridiculous that I had to wait out in the cold for hours when I was running a fever, but unfortunately that's how it goes these days if you don't have money and/or insurance.
Well, of course not! Don't you know that the ones that truly need the help are always the ones that get the shaft?
I am a nurse midwife and practiced in an underserved area. We provided care to low income women in seven counties that surrounded the hospital where we delivered babies. It was commonly said among the women patients that "They don't care about us, that's why they let midwives deliver us."
One patient's boyfriend dropped her off for her appointments in a vintage restored Corvette. She said they weren't married because then she would have to get insurance to pay for her prenatal care and the hospital.
I could go on and on about the women we served. . .the 15 year old who came to the hospital by EMS so many times that the relative of one of the staff who had a scanner and listened to police, fire and EMS calls would call and tells us the XXX was on her way, and sure enough, she would be rolled into L & D. I personally saw her 7 times during the pregnancy IN THE TRIAGE AREA for round ligament pain. She developed pre-eclampsia (who'd have thunk it? adolesent, first pregnancy, low-income). Told her that she needed to avoid foods that were high in salt. She goes home, eats a $1.98 bag of cheetos and comes into the triage area because her face and hands are swollen and the nurse midwife told her if that happened it was an emergency.
If patients want free/cheap meds, they can go to the free clinic with the homeless and uninsured (which is what I do when I get sick because I am broke and have no insurance- since I have been in school on and off to work on my prereqs, I haven't been employed full time anywhere for long enough in the past few years to qualify for my employers' health insurance plans).
Anyway, I was having weird pain in my side this past Summer and went to the non-profit clinic in Eugene, OR. It turns out it was the beginning of a shingles outbreak (which is weird because I'm only half way to 60), and they gave me a prescription of Valtrex for only $10. I paid $20 total for the meds and the visit to the clinic, and it stopped the shingles outbreak before it erupted (thank GOD!). I had to show up at the clinic at 6 am, and ran the risk of not being seen that day because they can only see a very limited number of patients. I also went there last winter when I had a bad throat infection. It was kind of ridiculous that I had to wait out in the cold for hours when I was running a fever, but unfortunately that's how it goes these days if you don't have money and/or insurance.
At least you have access to free/ low cost clinics. There are not any in this part of Wyoming. I cannot get health insurance because of pre-existing conditions. So if I get sick I just suffer. Rarely, I go to the doctor except for the required rx refill requiremnts. When I do, I'm asked why I waited so long. I tell them that I'm self pay and most times I cannot afford to pay. I have dial up Internet, no cell phone, no cable/satellite TV, and drive a 20 year old paid off car. I pay for my own prescriptions and I'm darn happy if I get samples occasionally. No I don't feel entitled but I would love to see some changes in the system. It seems that my taxes go to pay for insurance for the elderly, the disabled and the poor. However I cannot afford health care for myself.
At least you have access to free/ low cost clinics. There are not any in this part of Wyoming. I cannot get health insurance because of pre-existing conditions. So if I get sick I just suffer. Rarely, I go to the doctor except for the required rx refill requiremnts. When I do, I'm asked why I waited so long. I tell them that I'm self pay and most times I cannot afford to pay. I have dial up Internet, no cell phone, no cable/satellite TV, and drive a 20 year old paid off car. I pay for my own prescriptions and I'm darn happy if I get samples occasionally. No I don't feel entitled but I would love to see some changes in the system. It seems that my taxes go to pay for insurance for the elderly, the disabled and the poor. However I cannot afford health care for myself.
Fuzzy
That's exactly why I support healthcare reform. Our system is purely broken, and it's infuriating to me that the people in Congress arguing that we can't afford to fix it are for the most part the same ones who voted to give TRILLIONS of free money to the financial industry after they drove themselves into the dirt.
And in your situation- I definitely support doctors doing what they can to provide free samples or any free healthcare coverage in any way possible. But I think an earlier poster made a good point that many doctors who do so are in a bind because they are trying to spread their free samples around and don't have enough to give out to everyone who needs them. Talk about rationed healthcare!
I'm more inclined to give samples to those who don't ask for them.
What a perverse way to make a decision!
If you know the economic situation, insurance coverage, and stressors in patients' lives, you just might have enough information to make an intelligent decision about who gets a break for their meds.
But to make it like a game: Don't ask and you get it, is just gloating in the power you have, at the expense of the people who trust that they'll have fairness dealt them! :angryfire :angryfire
In my experience, it was the doctor who decided who got samples, as he/she usually had the information needed.
A couple of days ago I was prescribed a medication that I found out at the pharmacy I can not afford. Because I can not afford it, I did not have the prescription filled. I would feel thrilled if the doctor would give me samples so that I could receive the treatment. I do not believe that the doctor signs any kind of agreement with the drug rep as to who gets samples and who does not. I also do not like the implication that I want something for nothing. Since I can't afford the medication, I don't get the medication. End of story.
Please say you called and got a substitute that you could! Also, alot of the pharmaceutical companies have assistance programs. If its a medication you need for the long-term, consider looking into that.
i am a nurse midwife and practiced in an underserved area. we provided care to low income women in seven counties that surrounded the hospital where we delivered babies. it was commonly said among the women patients that "they don't care about us, that's why they let midwives deliver us."
so did you tell them the advantages of having their care provider with them earlier in labor, someone who truly empathized with them and intuitively knows how to be of assistance for them? doctors/obs are really handy when serious complications in l&d occur, tell them - but with normal deliveries, they walk in the door just as babies heads are about to pop out.......
one patient's boyfriend dropped her off for her appointments in a vintage restored corvette. she said they weren't married because then she would have to get insurance to pay for her prenatal care and the hospital.
did you know if the boyfriend got the corvette as a junker and restored it himself? was her response made to a question asked without the privacy necessary? there could have been other reasons she didn't marry him, none of which you had any right to know without having an agreement to do premarital counselling with her!
i could go on and on about the women we served. . .i'll just bet you could.......as you apparantly place yourself as the judge of them all!
the 15 year old who came to the hospital by ems so many times that the relative of one of the staff who had a scanner and listened to police, fire and ems calls would call and tells us the xxx was on her way, and sure enough, she would be rolled into l & d. that could be in violation of hippa, since there wasn't a need for you to know, so that equipment would be ready for her arrival......
i personally saw her 7 times during the pregnancy in the triage area for round ligament pain. did you suggest that she ask her doctor about having pt for exercises to minimize her perceived pain? when a frightened child (which i think she has all the hallmarks of being) has pain, it's worse than that encountered by someone who has matured, has a good support system, and is happy about beiung pregnant, she developed pre-eclampsia (who'd have thunk it? adolesent, first pregnancy, low-income). there were plenty of teenagers with toxemia in the maternity home where i was the nursing director. what made you think youth was protection from it?
told her that she needed to avoid foods that were high in salt. she goes home, eats a $1.98 bag of cheetos and comes into the triage area because her face and hands are swollen and the nurse midwife told her if that happened it was an emergency.
that was a cry for help if ever there was one! it could even have been a suicide attempt, if the cnm explained the consequences of advanced toxemia! often patients are given long lists of foods that contain too much sodium; and none of the foods on the permitted list are favorites..... it helps to let them know there is low salt peanutbutter, and jelly has little na, and then ask what foods they like to eat. you'd probably find that piquant foods, rather than sweets were that patients' favs. suggesting some herbs and spices (cinnamon, and others that won't cause excessive acid) might have gotten better cooperation. you'd be surprised to know how much it means to deliver health care information with a sense of caring - for every patient.
i am amazed by this...............i have never received a sample med from my doctor...........and have never worked in a setting that dispenses meds.....
@ my psych hospital where i work, we are not allowed to give any sample meds......they only get scripts.....a few ask for samples, but that is not the norm..............
unreal !!!!!!!!!!!!! the more i see & hear, the more i cannot understand.....
so what do you do about noncompliant patients who are uninsured, and can't afford $10/dose, as that is what many psychotropic drugs cost?
AngelfireRN, MSN, RN, APRN
2 Articles; 1,291 Posts
Well, of course not! Don't you know that the ones that truly need the help are always the ones that get the shaft?